PREVENTION & MANAGEMENT OF AGGRESSIVE BEHAVIOR By Evelyn Stone, RN., BSN. M.Ed.

Identifying Crisis Behavior Learn to stop a crisis before it starts What exactly is a crisis Maintaining a Safe Environment

What is a Crisis? Emotional event Radical change in a person’s life Crucial time Impending change Undesirable outcome

What Causes a Crisis StressFearAngerPain Emotional strain Physical strain Tension

What are Trigger Events? Initiates reaction Precipitates a reaction Internal physical changes Internal mental status changes External

Internal Physical Changes PainFatigueHungerIntoxicationWithdrawalCravingsADHD

Internal Mental Status Changes Hallucinations/DelusionsConfusionDepressionAnxiety Fear of Losing Control Perception of Threat Psychotic Distortion

External Triggers Threat of loss of freedom Challenge Loss of Autonomy Loss of Privacy Fear of Failure Challenge to Family/relationship Loss of job Challenge to Goals/Needs

Triggers (continued) Aggression occurs when one feels threatened Emotionally brittle persons are prone to anger Triggers are often repetitive Persons who are angry interpret closeness as a threat

Factors of Triggers Some act out to get attention from staff Individuals with conduct disorder may conspire so that one client acts out to create a diversion

Crisis Phases Pre-crisisEscalation Active Crisis Post Crisis

Pre-Crisis Emotionally Stable Problem Solving Abilities Exhibits state of functioning normally

Internal Experiences The client feels normal Mood and Emotions are consistent with the situation Feel Sad May feel Depressed Angry if treated unfairly

External Experiences Client is able to communicate & interact with friends, family and others May be very talkative, quiet or extroverted Normally shy Will be able to complete routine task

Escalation Phases De-escalate the client Avoid development of a crisis When client is in vulnerable state Something in the environment cause emotional distress Physical Distress

Internal Escalation Phase Discomfort within themselves Uncomfortable with the environment Client may feel needs are not being met May feel threatened in some way

Internal Escalation (continued) Pacing Talking louder than normal Fidgeting Rapid breathing Rapid speech Veins protruding

External Escalation Phase Ability to communicate is impacted Signs & Symptoms of stress, anger & anxiety Others may see s/s the client is about to “act out” or “lose it”

Active Crisis Phase Staff is to de-escalate client and make a safe environment Client feels emotionally stimulated Client feels hopeless and overwhelmed Staff

Internal Active Crisis FrustrationAngerAnxietyAgitationHopelessness Stress overwhelming

External Active Crisis Phase Communication is impaired Screaming, crying, or hitting others Attempting to harm self Kicking doors, hitting walls or trying to run away Viewed as “Out of Control”

Past Issues Refrain from discussing past issues ‘Here & Now” Defuse the crisis Defuse the crisis Stabilize the immediate crisis

Key Removing Concepts May become hypersensitive The threat of loss Logical choices Acting out

Post Crisis Phase Decrease of energy Abilities may drop Interventions

Legal Consequences Making threats Aggressive behaviors Reality checks Arrest Criminal charges

Three Abilities Affected by Crisis Coping ability Ability to listen or communicate rationally Changes in emotional equilibrium

Natural Consequences Stay up late & may be tired in the morning If you don’t eat your breakfast, you may be hungry Being rude to others, may cause others to avoid interacting with you

Crisis Development Four phases in development Pre-crisisEscalation Active crisis Post crisis

Star Making effective decisions Being unique Think, See, Respond Prevent conflict

Star Making effective decisions Being unique Producing effective intervention Think, see,then respond Prevent conflict

The Client OldYoung

The Environment lear